Procedure performed for CPT code 29806 Capsulorrhaphy

There is much confusion for coding orthopedic procedures and CPT Code 29806 is one of them. In addition, we have similar CPT Code 29807, which is also tricky when have to be used with CPT Code 29806. So, first we will just checkout how the whole procedure is performed.  The patient is positioned side lying with his arm suspended. Anesthesia is administered. Two to four small holes incisions are made around the shoulder joint to allow access to all the areas of shoulder joint.

A solution in injection through one of the holes to clean the joint for proper visualization. The arthroscope is then inserted to perform an arthroscopic diagnostic exam in the shoulder joint. The anterior capsule is visualized from a transverse incision of the subscapularis tendon. The joint is explored to check for any damage after the quality and laxity of capsule is assessed. The joint is irrigated to remove any loose bodies. If there is no abnormal laxity, the capsule is attached to the labrum with sutures.

Once the capsule is reattached, the subscapularis tendon is reapproximated but not tightened and repaired. The joint is irrigated and suture or steri-strip closes the incisions. Orthopedic procedures are very important for Medical coding Certification exam. Learning tips and techniques can help in Clearing CPC exam in future.

29806– Arthroscopy, shoulder, surgical; capsulorrhaphy

29807 repair of SLAP lesion

SLAP lesions are injuries to the labrum that extend from anterior to the biceps tendon to posterior to the biceps tendon. For a SLAP lesion repair, the physician makes small percutaneous incisions for the arthroscope, the suture hook, and the cannula. The surgeon prepares the bony bed with a small ball burr and drills or punches a hole at the cartilage bone junction of the superior labrum.

A hook is passed through the anterior superior portal and the inside limb is grasped with a suture retrieval forceps. The physician sets an anchor into the drill hole by mounting the suture anchor on the inserter and sliding it down the suture. The physician closes the loop with a slipknot that is tied and tightened outside the cannula. A knot pusher secures the knot under arthroscopic control. A long-acting local anesthetic may be injected into the joint to help with postoperative pain. The joint is irrigated and suture, band aid, or Steri-strips close the incisions. The area is covered with a dressing and a sling or shoulder immobilizer is applied.

Read also: Tips for Carpal Tunnel Syndrome Coding

Point to remember with CPT Code 29806

Use 50 modifier with CPT Code 29806 when the Capsulorrhaphy is performed on both sides bilaterally.

Surgical Arthroscopy always includes diagnostic arthroscopy.

Do use 51 modifier when the arthroscopy is performed with arthrotomy.

For open Thermal Capsulorrhaphy, use unlisted procedure CPT Code 23929.

For arthroscopic thermal capsulorrhapy, use unlisted procedure code 29999.

Read also: Coding tips for Knee Arthroscopic Procedures

Medically Unlikely Edits

An MUE for a HCPCS/CPT code is the maximum units of service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service. Not all HCPCS/CPT codes have an MUE.

(MUE Adjudication Indicator (MAI))

The MUE for CPT code 29806 is 1
The MAI is 2 Date of Service Edit: Policy
MUE Rationale: CMS Policy

NCCI edits for CPT code 29806